Shortened Lives: How location, lifestyle affect health

In their series "Shortened Lives," Suzanne Bohan and Sandy Kleffman found wide disparities in people's expected life spans, based on where they live, their social status and the toll of chronic stress. The series explains the effect these disparities have on health care costs, as well as how they are caused and how they might be addressed.

Bohan and Kleffman wrote about the project for AHCJ members and we have included additional resources for those interested in exploring disparities in health care in their own communities.

By Suzanne Bohan and Sandy Kleffman
Bay Area News Group

This project was launched during a California Endowment Health Journalism fellowship in 2008. We were both accepted for it, and learned we’d also pitched the same fellowship project: covering the wide differences in life expectancies and disease rates among richer and poorer ZIP codes in our region. And it’s a trend true everywhere.

So we teamed up, and won approval from management to embark upon a four-part series examining the causes behind this striking health gap between neighborhoods just miles apart.

Health by ZIP code

Leaders of our county health departments were enthused about the concept and offered assistance early in the project. Dr. Anthony Iton, who at the time was the Alameda County public health director, generously provided an epidemiologist to work with us.  The epidemiologist, Matt Beyers, offered invaluable expertise in creating a critical element of the series – maps showing life expectancies by neighborhood in two counties in our circulation area, as well as statistics on three diseases. His participation also added credibility to the project.

To create these maps, Beyers computed life expectancies, rates of heart disease and cancer deaths by ZIP code, as well as child asthma hospitalization rates.

Most of the data came from death certificates issued from 1999 to 2001, which list cause of death. We preferred something more current, but needed the age breakdowns by ZIP code that the 2000 Census provided. Beyers also said that while rates of what we were measuring probably changed slightly, the size of the health gap between rich and poor didn’t – and that was the gist of the story.

We needed Beyers’ expertise, since the analysis required someone skilled in adjusting for age differences among ZIP codes. Otherwise, areas with a large percentage of seniors or young children could skew the results, since heart disease and cancer usually strike people as they age.

For asthma hospitalization rates, he used hospital reports for 2002 to 2004 from California's Office of Statewide Health Planning and Development. The population and age breakdowns for those years came from data purchased by our marketing department from Nielsen Claritas, a marketing and demographic research firm.

Once Beyers compiled this data, he and our editorial graphics department created color-coded maps with it, and our online team developed an interactive version which allowed people to search for these statistics by ZIP code.

The maps revealed a stunning, 16-year difference in life expectancy for people living just 12 miles apart. A clear pattern emerged: People in the poorest neighborhoods live much shorter lives than others, and are sicker. They died of heart disease and cancer at three times the rate of people in more well-to-do communities.

Children living near busy freeways and a major port in low-income areas of Oakland were hospitalized for asthma at 12 times the rate of young people in higher-income neighborhoods nearby.

The maps and the series ran in the Contra Costa Times and Oakland Tribune, as well as a few of the chain’s other papers. The interactive map is posted online.

Bringing voices to the story

After the mapping project was underway, we turned our attention to finding ordinary people in our two counties to illustrate the issue. We upped the ante by deciding to seek subjects living in the ZIP codes with the lowest, highest and average life expectancies, which narrowed our options but told the most powerful story. We also sought to profile a child living in a neighborhood with high asthma rates who was struggling with the condition, and an adult with heart disease living in an area with high death rates from it.

This would help show how lack of access to good food, convenient transportation, decent housing and fear of crime in poor neighborhoods, among other factors, contribute to the chronic stress and exposure to pollutants which trigger these and other diseases.

We also showed how even the middle-class are affected by this health disparity, although less severely than poorer residents.

It proved challenging to find suitable profile subjects, as well as ones willing to have their lives described in newspapers. It took many dozens of calls and numerous dead ends before we finally found appropriate profile subjects.

Neighborhood groups, churches and nonprofits in these ZIP codes were called, as well as hospitals and clinics. The Alameda County Public Health Department helped find a subject in the neighborhood with the lowest life expectancy. These calls, and the many referrals they netted, finally yielded results; we found ideal subjects for all neighborhoods.

We then brought in an energetic photographer/videographer, who shot several videos and photos for the project.

Finding solutions

The series, however, needed to go beyond just reporting on the problem. Instead, the last two stories focused on the burgeoning movement to finally address the issue.

Public health leaders in our area have targeted this “health inequity” as unfinished business of the civil rights movement, since it mostly affects people of color. (Although a similar health disparity exists between the rich and poor whites living nearby in rural areas.) And they’ve developed novel programs. The Alameda County Public Health Department, for example, funds a “Time Bank” in one poor, crime-ridden ZIP code, allowing neighbors to swap services like gardening, cooking, babysitting or car repair. This “community capacity building” brings neighbors together and improves their odds of successfully advocating for more resources.

The final story focused on a little-discussed aspect of the health reform bill, which for the first time would commit federal funding to addressing social conditions that cause poor health.

We hosted online chats with Dr. Anthony Iton and Larry Adelman, producer of the acclaimed documentary series “Unnatural Causes.” We also ran an online chat with Dr. David Satcher, former U.S. Surgeon General, and Rich Hamburg, with the Trust for America’s Health, discussing how Health Policy legislation addressees these social determinants of health.

We received many responses from people around the country appreciative of the depth of coverage into a topic that’s received little attention. It also shows a new niche for health reporters: Covering the social determinants of health in one’s community, which health experts convincingly assert account for the majority of one’s health status.

The effort to find ordinary people living in these various neighborhoods also made all the difference with the story, and the effort was well worth it.

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Suzanne Bohan covers science and Sandy Kleffman covers health for the Bay Area News Group, a 653,000-circulation newspaper chain in the San Francisco Bay Area. This series appeared in the Contra Costa Times, Oakland Tribune and other BANG papers.